COVID-19 şüphesi nedeniyle pandemi polikliniğine başvuran hastalarda kardiyak etkilenmenin araştırılması
Abstract
Amaç: COVID-19 kardiyovasküler komplikasyonlara neden olabilen bir virüstür. Bu çalışmada, COVID-19 şüphesi ile başvuran göğüs ağrılı hastalarda kardiyak etkilenme olup olmadığı Elektrokardiyografi (EKG) bulguları eşliğinde araştırılmıştır.
Gereç ve Yöntem: Bu çalışma, Pandemi polikliniğine COVID-19 şüphesi ile başvuran göğüs ağrılı hastalar üzerinde prospektif olarak yapıldı. Hastalar PCR sonucuna göre: PCR sonucu pozitif ve negatif olmak üzere iki gruba ayrıldı. Tüm katılımcıların demografik özellikleri, başvuru şikayetleri ve şikayetlerinin mevcudiyet süresi, fizik muayene bulguları, laboratuvar sonuçları ve EKG bulguları kaydedildi. PCR sonucu pozitif olan hastalar, 15. günde kontrole çağırılarak yeniden EKG çekildi.
Bulgular: Çalışmaya 50 PCR sonucu pozitif ve 50 PCR sonucu negatif hasta dahil edildi. Tüm hastaların yaş ortalaması 52.30±16.02/yıl ve %56’sı kadındı. PCR sonucu pozitif olanlarla PCR sonucu negatif olanlar arasında yaş ve cinsiyet bakımından farklılık saptanmadı (Sırasıyla p=0.116; 0.687). Başvuru yüksek duyarlıklı kardiyak Troponin (hs-cTn) düzeyi, PCR sonucu pozitif olanlarda PCR sonucu negatif olanlara göre anlamlı olarak daha yüksekti (p<0.001). Başvuru EKG’sinde ST-T değişikliği saptanma oranı PCR sonucu pozitif olanlarda %38 iken, PCR sonucu negatif olanlarda ise %16 idi (p=0.023). PCR sonucu pozitif olan hastaların %36’sının 15. gün EKG’sinde ST-T değişikliği izlenmeye devam ediyordu. PCR sonucu pozitif olan hastaların başvuru EKG’sinde P-dalga amplitüdü ve ortalama kalp hızı değeri 15. gün EKG’sine göre anlamlı olarak daha yüksekti (Sırasıyla p=0.038; <0.001).
Sonuç: COVID-19 hastalarında kardiyak bir etkilenme olmakta ve bu durum EKG bulguları vasıtasıyla gösterilebilmektedir. PCR sonucu pozitif hastaların başvuru EKG’sinde saptanan P-dalga amplitüdündeki artış, COVID-19’a bağlı kardiyak yüklenmenin göstergesi olabilir. Göğüs ağrısı ile başvuran COVID-19 hastalarına hem başvuru anında hem de ilerleyen günlerde EKG çekimi yapılmalı ve oluşabilecek iskemik ST-T değişikliklerine karşı dikkatli olunmalıdır.
Keywords
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References
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-62.
- Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020; 116: 1666-87.
- Gaaloul I, Riabi S, Harrath R, et al. Sudden unexpected death related to enterovirus myocarditis: histopathology, immunohistochemistry and molecular pathology diagnosis at post-mortem. BMC Infect Dis 2012; 12: 1-7.
- Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020; 253: 117723.
- Abrams MP, Coromilas EJ, Wan EY, Rubin GA, Garan H, Dizon JM. Malignant ventricular arrhythmias in patients with severe acute respiratory distress syndrome due to COVID-19 without significant structural heart disease. Hear case reports 2020; 6: 858-62.
- Korantzopoulos P, Letsas KP, Tse G, Fragakis N, Goudis CA, Liu T. Inflammation and atrial fibrillation: a comprehensive review. J Arrhythm 2018; 34: 394-401.
- Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID‐19. J Cardiovasc Electrophysiol 2020; 31: 1003-8.
- Imazio M, Klingel K, Kindermann I, et al. COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis? Heart 2020; 106: 1127-31.
- Cuenin L, Lamoureux S, Schaaf M, et al. Incidence and significance of spontaneous ST segment re-elevation after reperfused anterior acute myocardial infarction-relationship with infarct size, adverse remodeling, and events at 1 year. Circ J 2018; 82: 1379-86.
- Lanza GA, De Vita A, Ravenna SE, et al. Electrocardiographic findings at presentation and clinical outcome in patients with SARS-CoV-2 infection. Europace 2021; 23: 123-9.
- Chorin E, Dai M, Kogan E, et al. Electrocardiographic Risk Stratification in COVID-19 Patients. Front Cardiovasc Med 2021; 8: 636073.
- McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic findings in coronavirus disease-19: insights on mortality and underlying myocardial processes. J Card Fail 2020; 26: 626-32.
- Li Y, Liu T, Tse G, et al. Electrocardiograhic characteristics in patients with coronavirus infection: A single‐center observational study. Ann Noninvasive Electrocardiol 2020; 25: e12805.
- Angeli F, Spanevello A, De Ponti R, et al. Electrocardiographic features of patients with COVID-19 pneumonia. Eur J Intern Med 2020; 78: 101-6.
- Bergamaschi L, D’Angelo EC, Paolisso P, et al. The value of ECG changes in risk stratification of COVID‐19 patients. Ann Noninvasive Electrocardiol 2021; 26: e12815.
- Yang H, Wei Z. Arrhythmia recognition and classification using combined parametric and visual pattern features of ECG morphology. IEEE Access 2020; 8: 47103-17.
- Acilci.net. P dalgası. Available online: https://acilci.net/p-dalgasi/ Access date: 2022
- Magnani JW, Gorodeski EZ, Johnson VM, et al. P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey. Hear. Hear Rhythm 2011; 8: 93-100.
- Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 819-24.
- Proietti R, Russo V, Sagone A, Viecca M, Spodick DH. Interatrial block: an under-recognized electrocardiographic diagnosis with important clinical-therapeutic implications. G Ital Cardiol (Rome) 2014; 15: 561-8.
- Yenerçağ M, Arslan U, Şeker OO, et al. Evaluation of P-wave dispersion in patients with newly diagnosed coronavirus disease 2019. J Cardiovasc Med (Hagerstown) 2021; 22: 197-203.
- Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9.
- Zhang J, Dong X, Cao Y, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy 2020; 75: 1730-41.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
- Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med 2020; 58: 1095-9.
- Cheng Z, Lu Y, Cao Q, et al. Clinical features and chest CT manifestations of coronavirus disease 2019 (COVID-19) in a single-center study in Shanghai, China. Am J Roentgenol 2020; 215: 121-6.
- Zhou X, Chen D, Wang L, et al. Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical. Biosci Rep 2020; 40: BSR20202690.
- TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 enfeksiyonu) erişkin hasta tedavisi, Bilimsel danışma kurulu çalışması. Available online: https://COVID19.saglik.gov.tr/Eklenti/43095/0/COVID-19rehberieriskinhastayonetimivetedavi-12042022pdf.pdf Access date: 2022
An investigation of cardiac effects in patients presenting to the pandemic clinic with suspected COVID-19
Abstract
Aim: COVID-19 is a virus capable of causing cardiovascular complications. This study investigates whether any cardiac effect is present in patients presenting with suspected COVID-19 in the light of Electrocardiography (ECG) findings.
Material and Method: This prospective study involved patients with chest pain presenting to the pandemic clinic with suspected COVID-19. Patients were divided into two groups based on their PCR results, PCR-positive and -negative. All participants’ demographic characteristics, presentation symptoms and the duration thereof, physical examination findings, laboratory results, and ECG findings were recorded. Patients with positive PCR results were invited for checks on the 15th day, when repeat ECG was performed.
Results: A-50 patients with positive PCR results and 50 with negative PCR results were included in the study. The mean age of the entire patient group was 52.30±16.02 years, and 56% were women. No difference was determined between the positive and negative PCR result patients in terms of age or sex (p=0.116; 0.687, respectively). Presentation high sensitive cardiac Troponin (hs-cTn) levels were significantly higher in the patients with positive PCR results than in the PCR-negative patients (p<0.001). Rates of detection of ST-T change at presentation ECG were 38% in the patients with positive PCR results and 16% in those with negative PCR results (p=0.023). ST-T alteration persisted at 15th day ECG in 36% of the patients with positive PCR results. P-wave amplitude and mean heart rate were significantly higher at presentation ECG in the patients with positive PCR results than at ECG on day fifteen (p=0.038; <0.001 respectively).
Conclusion: A cardiac effect does occur in patients with COVID-19, and this can be shown by means of ECG findings. The increase in P-wave amplitude at presentation ECG in patients with positive PCR results may represent a marker of COVID-19-related cardiac overload. ECG should be performed both at presentation and in the following days on COVID-19 patients presenting with chest pain, and care should be taken against potential ischemic ST-T alterations.
Project Number
Yoktur.
References
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-62.
- Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020; 116: 1666-87.
- Gaaloul I, Riabi S, Harrath R, et al. Sudden unexpected death related to enterovirus myocarditis: histopathology, immunohistochemistry and molecular pathology diagnosis at post-mortem. BMC Infect Dis 2012; 12: 1-7.
- Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020; 253: 117723.
- Abrams MP, Coromilas EJ, Wan EY, Rubin GA, Garan H, Dizon JM. Malignant ventricular arrhythmias in patients with severe acute respiratory distress syndrome due to COVID-19 without significant structural heart disease. Hear case reports 2020; 6: 858-62.
- Korantzopoulos P, Letsas KP, Tse G, Fragakis N, Goudis CA, Liu T. Inflammation and atrial fibrillation: a comprehensive review. J Arrhythm 2018; 34: 394-401.
- Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID‐19. J Cardiovasc Electrophysiol 2020; 31: 1003-8.
- Imazio M, Klingel K, Kindermann I, et al. COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis? Heart 2020; 106: 1127-31.
- Cuenin L, Lamoureux S, Schaaf M, et al. Incidence and significance of spontaneous ST segment re-elevation after reperfused anterior acute myocardial infarction-relationship with infarct size, adverse remodeling, and events at 1 year. Circ J 2018; 82: 1379-86.
- Lanza GA, De Vita A, Ravenna SE, et al. Electrocardiographic findings at presentation and clinical outcome in patients with SARS-CoV-2 infection. Europace 2021; 23: 123-9.
- Chorin E, Dai M, Kogan E, et al. Electrocardiographic Risk Stratification in COVID-19 Patients. Front Cardiovasc Med 2021; 8: 636073.
- McCullough SA, Goyal P, Krishnan U, Choi JJ, Safford MM, Okin PM. Electrocardiographic findings in coronavirus disease-19: insights on mortality and underlying myocardial processes. J Card Fail 2020; 26: 626-32.
- Li Y, Liu T, Tse G, et al. Electrocardiograhic characteristics in patients with coronavirus infection: A single‐center observational study. Ann Noninvasive Electrocardiol 2020; 25: e12805.
- Angeli F, Spanevello A, De Ponti R, et al. Electrocardiographic features of patients with COVID-19 pneumonia. Eur J Intern Med 2020; 78: 101-6.
- Bergamaschi L, D’Angelo EC, Paolisso P, et al. The value of ECG changes in risk stratification of COVID‐19 patients. Ann Noninvasive Electrocardiol 2021; 26: e12815.
- Yang H, Wei Z. Arrhythmia recognition and classification using combined parametric and visual pattern features of ECG morphology. IEEE Access 2020; 8: 47103-17.
- Acilci.net. P dalgası. Available online: https://acilci.net/p-dalgasi/ Access date: 2022
- Magnani JW, Gorodeski EZ, Johnson VM, et al. P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey. Hear. Hear Rhythm 2011; 8: 93-100.
- Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 819-24.
- Proietti R, Russo V, Sagone A, Viecca M, Spodick DH. Interatrial block: an under-recognized electrocardiographic diagnosis with important clinical-therapeutic implications. G Ital Cardiol (Rome) 2014; 15: 561-8.
- Yenerçağ M, Arslan U, Şeker OO, et al. Evaluation of P-wave dispersion in patients with newly diagnosed coronavirus disease 2019. J Cardiovasc Med (Hagerstown) 2021; 22: 197-203.
- Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9.
- Zhang J, Dong X, Cao Y, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy 2020; 75: 1730-41.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
- Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med 2020; 58: 1095-9.
- Cheng Z, Lu Y, Cao Q, et al. Clinical features and chest CT manifestations of coronavirus disease 2019 (COVID-19) in a single-center study in Shanghai, China. Am J Roentgenol 2020; 215: 121-6.
- Zhou X, Chen D, Wang L, et al. Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical. Biosci Rep 2020; 40: BSR20202690.
- TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 enfeksiyonu) erişkin hasta tedavisi, Bilimsel danışma kurulu çalışması. Available online: https://COVID19.saglik.gov.tr/Eklenti/43095/0/COVID-19rehberieriskinhastayonetimivetedavi-12042022pdf.pdf Access date: 2022
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Project Number | Yoktur. |
| Publication Date | December 26, 2022 |
| Published in Issue | Year 2022 Volume: 3 Issue: 4 |
TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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